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PLUM BING.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEI.CARATION I hacby affim und6 poalty of pcrjury thst I m qmpt from the Contrrcton' Licre lrw for thc following Iwn (Se.7031.5 Buinas atd Prcfsion Codc): Any City or County which rcquim a panit to coGtruct. alta, improrae domlfuh or Epsir ey struclurc, prior to its issumc. also rcquis thc applicet for such pcmit to filc 8 signcd stalmot thd hc or sha b licmcd pwant to thc provisioB of thc Cootractor's Licascd kw (Ch8pt6 9. Comming with Scrion 7000 of Division 3 of thâ‚¬ BuitB ed Proftsions Codc) or that hc or shc is cxcmpt thscfrom md thc bosis for thc allcged qmFion. Any violstion of Setion 703 I .5 by my applicutforapgrnitsubjetsahc spplicmttoscivilpddtyofnotmrcrhulivchundrcddollm(3500). _1. as owner of the property. or my employecs with wages as their solc compensation. will do the work and the snrcture is not intendod or offered for salc (Sec.7044. Business and Pr,ofesions Code: The Contractor's Licensc law does not apply to an owner of the propoty who builds or imp,rov6 theron. and who docs such wor* himself or hersclf or through his or her own employce. provided that such improvanrents arc not intcrrdod oroffood for sah. If. however. the building or improvement is sold within one ),ear of complaion. the Orvner Buildcr will have the burden of proving thd he or she did not build or imp,rove the propoty for the purpose of sale). _1. as owner of the propcrly. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Buiness and Pnoftssion Code: The Contractor's Liccnse Law does not apply to an owner of property who builds or improves thereon, and who contracts for such p,rojecrs with a Contractor(s) licarsed pursuant to the Contractor's Liccnse Law). -l am exempt under Section-. B. & P.C. for this reason. O*ner WORKERS' COMPENSA DECLARATTON one of the following declarations:I hereby affrrm under penalty of perjury _l have and will maintain a Certificate of Conscrt to Self-lnsurc for workers' compcnsaion. as provided for by Section 3700 of the Section 3700 of the Labor Code, for the performance of carrier ard policy numbcr are: Policy Nu^a"r,llL6d4.Oh$o Expires:1,,*,-I '-I _l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manncr so as to becorne subject to the workcrs'cornpensation laws of California. and agree that if I should become subject to the workers' compersation provisions of Section 3700 of the tabor Code. t shall. forthwilh comply with those provisions.. WARNING: Failure to sccure workers' compensation coverage civil fines up to one hundred thousand dollars ($100.000). in is unlawful, and shall subject an anployer to criminal ponhics and compersation. damages as provided for theto the of Section 3076 of the labor Code interest and attorncy's fees. DECIARATION I hereby afnrm under pcnalty of pcrjury that I am licensod undcr povision of Chaptcr 9 (commencing with Soction 7000) of Division 3 of the Business and Professions Code, and my licque is in full force and efhct. [.icensc W I hcby alftm undo paalty of pajury thd thft b s oonrudbr kndiog ag@y for thc psfomc of thc rcrL 6r which this pqmit ir iseucd (Se. 3097, Civ. C.). l.crrtlt'r 's Nittttc Lcnder's Ad&ess: APPLICANT DECLARATION I ho,,ey affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Fcderal Regulations (Title 40, Part6) -Required Letter of Notification _l certi& that the federal regulations rcgarding asbestos rernoval are not applicable to this project. -l certi& tha I have read this application and that the information is correct. I agrce to comply with all City and County ordinanccs and State Laws relating to building represertatives of this City and County to enter upon the above mentionod properly for inspection Applicant or Agent Perrnilee nnme and ,,,",tlln kma UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer Area/Storm Drain I nterceptor/ CIa rifier TOP OUT Waste & Vent Water Pipinq Gas Pipinq Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Roush Plumbins Final Gas Test Meter Release FINAL /2-L-O rLL /C^J efu9 4.27 Notes, Remarks, Etc. o,,",l\wl4ptp ,,..*.*rJ[[* (lonlrRctor: